USING FAMILY-BASED INTERVENTIONS TO FIGHT ANOREXIA NERVOSA By Molly Howard Objectives:

1. USING FAMILY-BASED INTERVENTIONS TO FIGHT ANOREXIA NERVOSABy Molly HowardObjectives: • To understand what a family-based intervention is • To learn how family-based interventions treat patients with Anorexia Nervosa (AN) • To become acquainted with the Maudsley Method (MM)

2. WHAT IS A FAMILY-BASED INTERVENTION? • Treatment involving all family members together • Treatment that seeks improvements in – • Family Dynamics • Communication • Specific Problems • Short term treatment

3. DESCRIPTION OF ANOREXIA NERVOSA (AN) • Eating disorder characterized by a fear of weight gain and food • Mental illness, not a diet • Patient has distorted image of self • Highest mortality rate of any mental illness

4. STATISTICS ASSOCIATED WITH AN • Ten million females and 1 million males suffer in the US (NEDA). • Leading cause of death among females between the ages of 15-24 (Anorexia Nervosa) • Of those who survive - • 47% recover fully • 33% improve somewhat • 20% remain chronically ill (Smith)

5. HISTORY OF USING FAMILY-BASED TREATMENT (FBT) ON PATIENTS WITH AN • 1978 • Dr. Salvador Minuchin in Philadelphia • Concentrated on “psychosomatic families” (Smith) • 86% success rate

6. FBT = THE MAUDSLEY METHOD • 1987 • Named after the Maudsley Hospital in London • Replaces parental blame with empowerment • 3 phase outpatient treatment • Focuses on weight gain and not the cause of AN

7. GOALS OF FBT • Family goals • Strengthen bonds between all members • Understand the disease affects all members • Remove anger and guilt • Encourage all members to support each other

8. GOALS OF FBT • Individual goals • Phase 1 – Adequate weight gain to restore patient to normal level • Phase 2 - Control over food and mealtimes • Phase 3 - Return to normal growth and development

9. WHO BENEFITS? • Patients • Parents • Families • Local resources

10. PHASE ONE • Family sessions with certified MM therapist • Parents given control • Therapist watches one meal • Parents feed 3 meals and 3 snacks per day. • Siblings provide support. • Average duration is 10 weeks (Smith). • Must achieve 90% Ideal Body Weight (IBW)

11. PHASE TWO • Patient gets control of own eating. • Must continue to gain weight • No signs of rebellion • Must conquer social settings without restriction

12. PHASE THREE • Counseling begins to understand root cause • Establish boundaries within family • Address developmental issues

13. MAIN POINTS OF FBT • Family members can be angry at the disease, not at the patient. • AN will not go away unless there is treatment. • No one caused AN, and no one is to be blamed. • Parents are in control of the child’s eating habits until weight is returned to normal.

14. SUCCESS OF FBT • Only 10% relapse rate after 1 year • Compared to 40% for those who did individual therapy • Only 10% relapse rate after 5 years • Compared to 36% for those who did individual therapy

15. CRITICISM OF FBT IN TREATING AN • Erosion of trust between parent and child • Introduces too much conflict within family • No individual therapy

16. MULTIPLE CHOICE QUESTIONS: 1. In the Maudsley Method, the primary focus is on a. Improving family dynamics b. Recovery of the patient’s health c. Finding the cause of the AN d. Better communication 2. A University of Pittsburgh study shows that AN is caused by an excess of this chemical in the brain? a. Serotonin b. Epinephrine c. Dopamine d. Histamine 3. Family-based treatment for AN does all of the following except: a. Empowers parents to feed the child b. Tells family members to support the patient c. Tells family members to be angry at the disease, not the patient. d. Places the blame for the disease on the parents.

17. MULTIPLE CHOICE QUESTIONS 4. Which is not a goal of family-based treatment? a. To place the patient in an inpatient facility b. To strengthen family bonds and relationships c. To remove anger and guilt about the disease d. To help the patient gain weight and recover from AN 5. Which statement is a criticism of family-based treatment? a. FBT causes families to spend too much time apart. b. FBT causes too much conflict inside the family. c. FBT is too expensive because of the high cost of inpatient care. d. FBT blames the parents for causing AN.

18. SHORT ANSWER QUESTIONS: • Using the Maudsley Method, ___________ are put in charge of feeding the patient with AN. • The Maudsley Method got its name from a ____________. • The Maudsley Method is a form of _______ ________ treatment.

19. SHORT ANSWER QUESTIONS • The goal of Phase 1 is the restoration of the patient’s _________. • Returning control of feeding herself to the patient is the goal of Phase _____.

20. REFERENCES Anorexia Nervosa (n.d.). In National Alliance on Mental Illness. Retrieved November 5, 2011, from http://www.nami.org/ Dubansky, H. (2010). Family-based therapy: An eating-disorder treatment that works. US News and World Report. Retrieved fromhttp://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2010/10/04/family-based-therapy-an-eating-disorder-treatment-that-works_print.html Findlay, S., Pinzon, J., Taddeo, D., & Katzman, D. (2010). Family-based treatment of children and adolescents with anorexia nervosa: Guidelines for the community physician. Paediatricsand Child Health, 15(1), 31-35. Retrieved from http://www.ncbi.nlm.nih.gov.ezaccess.libraries.psu.edu/pmc/articles/PMC2827322/ (n.d.). In Anorexia Nervosa and Associated Disorders (ANAD). Retrieved November 7, 2011, from http://www.anad.org/news/the-hidden-health-crisis-on-campus-eating-disorders/ (n.d.). In National Eating Disorders Association. Retrieved November 6, 2011, from http://www.nationaleatingdisorders.org/ (n.d.). In National Institute of Mental Health. Retrieved November 7, 2011, from http://www.nimh.nih.gov/index.shtml Smith, A., & Cook-Cottone, C. (2011). A Review of Family Therapy as an Effective Intervention for Anorexia Nervosa in Adolescents. Journal of Clinical Psychology in Medical Settings, doi:10.1007/s10880-011-9262-3